A RETROSPECTIVE EVALUATION ON THE SURGICAL MANAGEMENT OF CHRONIC ANAL FISSURE WITH DIFFERENT METHODS OF ANAESTHESIA

Dr. Subhash Chander Grover

Abstract


INTRODUCTION : Fissure-in-Ano or Chronic Anal Fissures (CAF) is a linear ulcer in the squamous epithelium of the anus, distal to the dentate
line & one of the most common and painful anorectal conditions encountered in surgical practice. Surgeons working in a rural setups and First
Referral Units are faced with several challenges and limitations. Patients undergoing surgery under spinal anaesthesia have to undergo a battery of
blood tests and imaging as a result for poorer patients the cost of treatment becomes manifold. This retrospective study was aimed to compare the
outcome of lateral anal sphincterotomy (LAS) for chronic anal fissure, done under Spinal Anaesthesia and Local Anaesthesia.
METHODS: This Retrospective study involved Prior Consent from the Hospital Authorities & was found to be within ethical standards . Data of
200 patients were selected which were proven cases of Chronic Anal Fissures admitted to the local surgical units in last 4 years. Subjects included
both the genders , all age groups including pediatric and geriatric age group and all classes of socio economic strata.
RESULTS: Data of total 200 patients were obtained , out of 200 participated 127 were women and 73 were men. A total of 100 patients (50%)
underwent LAS under local anaesthesia and 100 patients (50%) underwent LAS under spinal anaesthesia. The mean age of the patients was 41.37
years with Standard Deviation of 3.42 years. There was No Statistical Difference between the two groups in terms of Intraoperative and
Postoperative Complication like Pain , Incontinence & Infection after follow up.
CONCLUSION: Lateral anal sphincterotomy (LAS) provides very good healing of Chronic Anal Fissure. Few distinct advantages were noted in
the study while doing LAS under LA. It provides adequate pain relief for the procedure apart from the advantage of easy palpability of the
sphincter. It can be done as an Outpatient procedure without the need for an anaesthetist, and carries a significant cost benefit to the patient
especially in lower socio-economic settings.There is no significant difference in the complications or the healing of the fissure when compared with
SA


Keywords


Fissure-in-ano , Lateral Anal Sphincterotomy, Spinal Anaesthesia , Local Anaesthesia , Retrospective Study.

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